Provider Demographics
NPI:1467909119
Name:MOSQUERA NINO, ALFREDO ALEJANDRO (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:ALEJANDRO
Last Name:MOSQUERA NINO
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3780 COPPERFIELD DR APT 813
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5886
Mailing Address - Country:US
Mailing Address - Phone:330-245-7982
Mailing Address - Fax:
Practice Address - Street 1:1228 TAMU
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-3370
Practice Address - Country:US
Practice Address - Phone:979-845-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT86112255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer